Sierra Cristina, de la Sierra Alejandro
Hypertension Unit, Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, 170-Villaroel, 08036 Barcelona, Spain.
Curr Opin Nephrol Hypertens. 2005 Sep;14(5):435-41. doi: 10.1097/01.mnh.0000174397.59100.89.
To review the antihypertensive, cardiovascular and pleiotropic effects of angiotensin-receptor blockers (ARBs).
ARBs are the most recently approved class of antihypertensive agents. They selectively block the angiotensin II type 1 receptor, thus inhibiting most of the deleterious effects of angiotensin II. In addition to blood-pressure control, other benefits may be gained using ARBs. This is because the renin-angiotensin system plays a crucial role in circulatory homoeostasis, and in patients with atherosclerosis, diabetes or hypertension, angiotensin II contributes to the pathophysiology of disease. Evidence-based medicine includes well-controlled studies with mortality and morbidity endpoints in patients with a variety of conditions including hypertension, type 2 diabetes, stroke, renal disease, heart failure, left-ventricular hypertrophy and coronary heart diseases. In addition to these hard endpoints, it has been shown that treatment with ARBs prevents the development of type 2 diabetes, ameliorates coronary and peripheral vascular endothelial dysfunction and decreases plasma levels of several markers of vascular inflammation.
ARBs are first-line agents for the treatment of hypertension and cardiovascular diseases. Blocking the renin-angiotensin system with these agents has special advantages due to specific vascular and antiatherosclerotic effects, which contribute to a better cardiovascular and renal protection in patients at risk from or with cardiovascular disease.
综述血管紧张素受体阻滞剂（ARB）的降压、心血管及多效性作用。
ARB是最近获批的一类抗高血压药物。它们选择性阻断血管紧张素II 1型受体，从而抑制血管紧张素II的大部分有害作用。除控制血压外，使用ARB还可能带来其他益处。这是因为肾素-血管紧张素系统在循环稳态中起关键作用，而在动脉粥样硬化、糖尿病或高血压患者中，血管紧张素II参与疾病的病理生理过程。循证医学包括在患有多种疾病（如高血压、2型糖尿病、中风、肾病、心力衰竭、左心室肥厚和冠心病）的患者中进行的以死亡率和发病率为终点的严格对照研究。除了这些硬性终点外，研究表明，ARB治疗可预防2型糖尿病的发生，改善冠状动脉和外周血管内皮功能障碍，并降低多种血管炎症标志物的血浆水平。
ARB是治疗高血压和心血管疾病的一线药物。由于其特定的血管和抗动脉粥样硬化作用，使用这些药物阻断肾素-血管紧张素系统具有特殊优势，有助于为有心血管疾病风险或患有心血管疾病的患者提供更好的心血管和肾脏保护。
